Clinical And Laboratory Characteristics Of Acute Myeloid Leukemia With Eosinophilia

?.Clinical and laboratory characteristics of acute myeloid leukemia with eosinophiliaObjectiveThe clinical and laboratory data of patients with acute myeloid leukemia(Eo+-AML)with eosinophilia admitted to the first affiliated hospital of Soochow university from January 2007 to January 2019 were retrospectively analyzed and summarized to learn the clinical and laboratory characteristics of Eo+-AML patients in our center.MethodsCollecting 13 years in first affiliated hospital of suzhou university onset of 161 casesof Eo+-AML in our hospital clinical and laboratory data,such as gender,age,peripheral blood cells count,percent of bone marrow blast cells,bone marrow eosinophils,flow immunity subtypes,karyotype,fusion gene,gene mutation.ALL cases was mainly grouped into three parts according to the cytogenetic analysis.Results1.161 cases of primary Eo+-AML were included in this analysis,which were mainly divided into three groups according to karyotype,namely inv(16)/t(16;16)group(59/161,36.6%)?t(8;21)group(22/161,13.7%)and normal karyotype group(21/161,13.1%).The median age of all patients was 34 years old(range from 9-68).The ratio of male to female was 1.3,and the age distribution and sex ratio were of no significant difference between the three groups.2.WBC and Hb were significantly different(P=0.046 and P=0.002)when t(8;21)group compared with the normal karyotype group,that is in t(8;21)group,WBC and Hb were lower than normal karyotype group.Bone marrow eosinophil count in inv(16)/t(16;16)group was significantly higher than that of t(8;21)and normal karyotype group(12%vs7%vs6.5%),while the percent of bone marrow blast cells was of no difference in this three groups.In inv(16)/t(16;16)group,the expression of flow immunity subtypes was mainly dominated by the medullary system and the medullar-mono system,while both the t(8;21)group and normal karyotype group were dominated by the medullary system,and the double expression can be both observed in this two groups.The positive rates of CD34 and MPO in inv(16)/t(16;16)group were significantly different from normal karyotype(P=0.00 and P=0.041),and the expression of immunity molecules in t(8;21)group and normal karyotype group is similiar(P>0.05).3.Gene mutation of Eo+-AML patients were mainly C-KIT(28.6%),CEBPA(26.5%)and FLT3(24.5%).There was no C-KIT mutation in normal karyotype group but replaced by the CEBPA mutation(50%)and there was no difference between the t(8;21)group and normal karyotype group.4.Among the three groups,inv(16)/t(16;16)group had the highest CR rate(89.1%),followed by t(8;21)group(84.2%)and normal karyotype group(65%),and there was a significant difference in CR rates between inv(16)/t(16;16)group and normal karyotype group.Conclusion1.102 cases with Eo+-AML were included and divided into three groups according to cytogenetic abnormalities.Inv(16)/t(16;16)are the most common,followed by t(8;21)group and normal karyotype group.2.Inv(16)/t(16;16)group presented higher bone marrow eosinophil than the other two groups,which may be one of the key factors affecting prognosis.However,WBC?HB?PLT?LDH and the percent of bone marrow blast cells have similar common features as well as differences among the three groups.3.C-KIT mutation was the most common in Eo+-AML,followed by CEBPA and FLT3 mutation,and the mutation rate of C-KIT and CEBPA in inv(16)/t(16;16)group differed significantly from normal karyotype group.4.CR rate of inv(16)/t(16;16)group was higher than that of the other two groups,which may be related to its higher sensitivity to chemotherapy.?.AML with eosinophils and inv16/t(16;16)clinical and laboratory features and prognostic effectsObjectiveClinical and laboratory data of AML with Eo+/Eo-and inv 16+/inv16-treated in our hospital during 13 years were retrospectively analyzed,and the prognostic impact of Eo and inv16 on AML patients was discussed.MethodsCollected 165 cases of AML with Eo+/Eo-and inv16+/inv16-who were admitted to the First Affiliated Hospital of Soochow University from January 2007 to January 2019,including gender,age,peripheral blood,LDH,extramedullary infiltration,proportion of bone marrow blasts,proportion of bone marrow eosinophils,number of megakaryocytes,immunotyping,karyotype,fusion gene,gene mutations,etc,were grouped according to the positivity of Eo and inv16,and the clinical and laboratory characteristics of patients under different groups and related factors affecting prognosis were discussed.Results1?A total of 165 patients were included in the analysis,including 107 cases(64.8%)in the Eo+ inv16+ group,31 cases(18.8%)in the Eo+inv16-group,and 27 cases(16.4%)in the Eo+inv16+ group,with a median incidence of disease 34 years,42 years,and 33 years respectively.Among the gender ratios,male:female=1.5,and males were dominant in the three subgroups.There were no significant differences in age distribution and gender ratio among the three groups.2?In terms of peripheral blood and bone marrow,the Eo+inv16-group and the Eo-inv16+ group were compared with the Eo+ inv 16+group,respectively.There were no significant differences in the number of megakaryocytes,central nervous system involvement,and extramedullary infiltration.On the Eo+inv16+ group,the bone marrow Eo was significantly higher than that in the Eo+inv16-group and the Eo+inv16+ group(11.5%vs.7%,11.5%vs.3%),and in the Eo+inv16+ group and the Eo+ inv16-group,the proportioin of Eo is mainly among 5-10%.In immunophenotyping,three groups of patients highly expressed stem cell antigen CD34 and myeloid antigens CD13,CD33,and CD117.The expression of lymphocyte antigens in the Eo+inv16+group was predominantly CD2(38.1%),occasionally CD19 and CD7(3.1%and 2.1%).The expression of lymphocyte antigens in the Eo+inv16-group was mainly CD7(40.7%).but the expressions of CD2 and CD 19 were low(11.1%and 7.4%),and the differences in the expression of CD7 and CD2 antigens were statistically significant between the two groups(P<0.05),In Eo-inv16+ group,all patients expressed CD34 antigen,and only 1 patient expressed CD7 antigen.Compared with the Eo-inv16+ group and the Eo+inv16+ group,except for CD2 and MPO,the expression of each antigen was basically no difference between the two groups.3?Among the overall patients,the highest positive mutation rate was C-KIT mutation(31/125,24.8%),the others were FLT3,K/NRAS,CEBPA,DNMT3A,and NPM1 mutations.The most common gene mutations in the Eo+inv16+ group were C-KIT(30.4%),KRAS/NRAS(15.9%),and FLT3(14.5%),while the Eo+inv16-group was mutated with CEBPA(38.1%)and NPM1(19%),The mutation type and frequency trend of Eo-inv16+ group is the same as that of the general patients.The positive rates of C-KIT,CEBPA and NPM1 mutations are significantly different betweenEo+inv16+ group and Eo+inv16-group(P<0.05),that is,Eo+inv16+group was dominated by C-KIT mutations,while the CEBPA and NPM1 mutations were dominant in the Eo+inv16-group.There was no significant difference in the incidence of each type of mutation in the Eo+inv16-group and the Eo-inv16+group.4?Univariate survival analysis showed that the proportion of bone marrow eosinophils and the presence or absence of inv16 had no effect on the prognosis.Survival curve analysis showed there was no significant difference in overall survival among the three groups,but the median survival time suggested that Eo+inv16+ group(91.3 months)>Eo+ inv16-group(83.2 months)>Eo-inv16+(76,34 months).Conclusion1?Among the AML patients with Eo+/Eo-and inv16+/inv16-,Eo+inv16+ patients were the majority,and all the groups of patients were mainly males.The age distribution and gender ratio were in the three groups of no difference.2?The Eo+inv16-group and the Eo-inv16+group were compared with the Eo+inv16+ group respectively,and their peripheral blood leukocytes,platelets,eosinophils,LDH.bone marrow blast counts,megakaryocytes,central nervous system There was no difference in involvement and extramedullary infiltration.Among the three groups,Eo+inv16+ group has the highest proportion of Eo,and most of them are concentrated in 5-10%.The three groups of immunotyping were mainly based on the expression of stem cell and myeloid antigens,but the expression of lymphoid antigens were different.3?Examination of genetic mutations showed that the most frequent mutations were C-KIT,CEBPA,and FLT3,and the first two types of mutations were significantly different between the Eo+inv16+ group and the Eo+inv16-group(P<0.05).There was no significant difference in the incidence of all types of mutations between the Eo+inv16+group and he Eo-inv16+ group.4?Univariate survival analysis showed that the number of Eo and the presence or absence of inv16 had no effect on the prognosis.The median survival time suggested that inv16 and Eo may be influential factors for the patient's prognosis.More data are needed to further prove it.?.Clinical and laboratory characteristics of t(8;21)AML with eosinophiliaObjectiveTo analyze 84 cases of t(8;21)AML with Eo+/Eo-in our hospital from January 2007 to January 2019,and to explore Eo prognostic impact on t(8;21)AML.MethodsCollect clinical information of t(8;21)AML with Eo+/Eo-admitted to the First Affiliated Hospital of Soochow University from January 2011 to January 2019.The main items are basically the same as the first and second parts.The clinical and laboratory characteristics of patients with Eo+/Eo-and the effect of Eo on the prognosis of patients were discussed.Results1?All of the t(8;21)AML,62 were Eo--t(8;21)AML(73.8%),and 22 were Eo+-t(8;21)AML(26.2%).The median age of dignosis in all patients was 39 years,of which the Eo-group was 37 years old and the Eo+ group was 44 years old,and there was no difference in age distribution(P=0.851).The Eo-group was mainly male,and Eo+group was mainly women,and the gender difference between the two groups was statistically significant(P=0.027).2?In terms of peripheral blood and bone marrow,the levels of WBC,HB,PLT,and LDH in peripheral blood were not different between the two groups.Eo+ group and Eo-group had 33%and 47.3%bone marrow blasts respectively.And the former group was less than the latter group,and the difference was significant(P=0.006).In terms of immunophenotyping,the expression of stem cell antigen CD34,myeloid antigen CD 117,CD 13,CD33,and lymphoid antigen CD 19 were the most in the two groups,and the expression of each antigen was not significantly different.3?In terms of cytogenetics and molecular biological examination,karyotypes of patients in both groups were mainly associated with sex chromosome deletion and simple t(8;21)abnormalities,and the proportion of additional sex chromosomal abnormalities was higher than that of t(8;21)abnormalities.C-KIT(31.6%)and FLT3(13.2%)were the most frequent types of molecular mutations associated with the TK pathway in all patients,,and the mutation rates of FLT3,CEBPA,and NRAS were not significantly different between the two groups.4?The analysis of bone marrow Eo-related factors showed that the age of diagnosis was negatively correlated with the bone marrow Eo.The higher the age,the smaller the bone marrow Eo.Univariate survival curve analysis showed that in addition to bone marrow Eo and bone marrow transplantation,age of diagnosis peripheral blood leukocytes,platelets,and LDH levels had no significant effect on OS and EFS in the two groups.In Eo-group,Eo?3%showed significant OS and EFS survival advantages over Eo<3%,and OS in the Eo+group was significantly better than that in the Eo-group.Conclusion1?Among t(8;21)AML patients,Eo"group was the most common.There was no significant difference in age distribution between the two groups.Eo-group compared with Eo+group,the former had significantly more male patients.2?The proportion of bone marrow blasts in the Eo-group was significantly higher than that in the Eo+group,and there were no significant differences in other clinical indicators between the two groups.The antigen expression of the two groups of patients was mainly CD34,CD117,CD13,CD33,and CD19,and there was no significant difference between the both groups.3?Karyotypes in both groups were mainly associated with sex chromosome deletions and simply t(8;21)abnormalities and they were no significant differences between the two groups.The genetic mutation types were mainly C-KIT,and C-KIT,CEBPA,NRAS mutation rates were not significantly different between the two groups.4?The age of diagnosis of patients was negatively correlated with the proportion of bone marrow Eo.In the Eo-group,Eo?3%showed a significant OS and EFS survival advantage over Eo<3%,and Eo+group had a significant OS than that in Eo-group.